I’ve decided to keep count of my small victories as the big ones are so few and far between.

My first little win is eating a salad. It might not seem like much, but between my fussy, nauseated migraine brain and the general difficulty of organising my household chores my daytime meals have been mostly toast-based recently.

I believe that having self-compassion is essential if I’m going to live a meaningful life with chronic illness. Unfortunately I’m not very good at it. I think developing self-compassion can encourage us to take good care of ourselves, to be accepting of our limitations and appreciative of our efforts.

For some of us self-compassion isn’t something we developed as we grew up, or we lost it along the way. Instead we have an extremely vocal and opinionated inner critic. This critical voice is always pointing out our failings, worrying about our weaknesses and generally making life even harder than it needs to be. I’m engaging with Compassion Focused Therapy (CFT) to learn to be as kind to myself as I would want to be to others.

A note of caution:

“Some people find that when they practice self-compassion, their pain actually increases at first.”
Kristin Neff

I discovered this exercise through a course in Compassion Focused Therapy. It wasn’t designed as a stand-alone exercise but as part of a self-help book or counselling programme.

If you’re interested in trying this exercise or exploring Compassion Focused Therapy yourself you might first like to read these tips for practice from Kristin Neff.

Why examine our personal stories?

Paul Gilbert explains that we can get stuck with an overactive or overprotective threat system if underlying fears or beliefs are being triggered in a particular situation. Identifying our underlying fears and beliefs, and where they come from can:

1) Change how we label the fears

2) Encourage a compassionate response

He says:

“The point I’m making here is that the reason some people can get stuck in the threat/self-protection system and not be able to settle it down may be because there are sets of interconnected frightening themes or memories at play. Notice that, once we understood Kim*, we were much less likely to see her fear as a ‘pathology’ or ‘illness’ in the medical sense, or that it was just about her being irrational or having faulty thinking. Notice, too, that your understanding will naturally pull you into a position of compassionate feeling, where the focus is on seeing clearly how and why the threat/self-protection system is playing up (i.e. only doing its best) and exploring how to reassure it and settle it.”

Paul Gilbert The Compassionate Mind (p. 146)

*’Kim’ is a case study. The details of her story aren’t important here.

I have found this helpful because I think I have had a tendency to see my coping strategies as being part of my personality. While I do see my tendency to worry and perfectionism as a coping strategy that can be useful (but also causes a lot of problems) I also tend to think of it as a trait – that I am a worrier and I am a perfectionist by nature. Adopting Paul Gilbert’s understanding of coping strategies as a response to an underlying fear or belief makes me feel like I have a bit more freedom to change (although I think that’s going to be very difficult to put into practice). I can also see that this will give me a much kinder way of responding when my perfectionist tendency is getting in the way. Instead of getting cross with myself for wasting time on unimportant details, I can remind myself that this is just a way of trying to protect myself, and that I have a much better alternative in my soothing techniques.

Investigating my fears, beliefs and experience around illness

In chapter 4 of Mary Welford’s book, The Compassionate Mind Approach to Self-Confidence, there is a diagram that can be used as a template for making sense of our experience, fears and beliefs and coping strategies. The example below is exploring my easily provoked anxiety that I’m not doing enough to get better and so somehow my health problems are my fault.

After doing the exercise:

• I can see how my fears have developed out of childhood experiences and cultural environment. They make sense in this context.
• I can argue against all my fears rationally. I can see that they aren’t supported by evidence or experience but that doesn’t seem to change how I feel. This exercise helps me see that my fears go back a long time and have deep roots so won’t easily be unsettled. And while they might not fit with the evidence, they do make some sense on some level.
• Likewise the coping strategies worked or made sense at some point. But now circumstances have changed and I want to find new and better ways of coping.
• I felt a great deal of sadness doing this exercise. And I felt quite exposed and vulnerable talking about my fears and beliefs.
• Quite a powerful antidote to the idea that there is some fundamental flaw in my personality or make-up that leads to me feeling so bad about myself.

My fears and beliefs around chronic illness:

• I won’t be believed
• It will turn out that other people were right not to believe me – I’m weak or ‘got above myself’ and made myself ill.
• My illness is my fault.
• I’m not doing enough to get well.
• I’m letting other people down.

The powerful way some of these beliefs generate threat and fear is their connection to two core beliefs:

• I’m not good enough (and I have to compensate for this or I’ll be rejected)
• I’m to blame/will be blamed if things go wrong I mustn’t make mistakes or I’ll be rejected)

Understanding Others

As I was looking at my diagram I realised I could use this diagram to think about why people might say unhelpful things. One phrase I have often heard but find very unhelpful is “if it was me I’d do anything to get better”. I’ve added it to my ‘Past Experiences’ column. It links to fear that I’m not doing enough, or that people don’t think I’m doing enough and so they will criticise or reject me. At the moment my unhelpful coping mechanism is to worry and ruminate. I also feel irritated by the lack of understanding and the implicit criticism. I though using this diagram might be a way of putting myself in someone else’s shoes and trying to imaging what might make them voice such a thought.

I tried putting ‘saying “if it was me I’d do anything”‘ in the strategies column to see if it would help me to imagine the kind of experiences, fears and beliefs might produce this response. I hoped that thinking of the phrase as someone else’s coping strategy might make it feel less of a personal criticism.

I was able to put together a plausible (though not necessarily true) story as to why someone might believe or say that. The story I came up with is that it is frightening to think that anyone of us can get ill and have huge changes to our career, or physical ability and our lifestyle thrown upon us. It might make sense to protect yourself from this reality by reassuring yourself that if it happened to you, you’d find a way to keep your ‘normal’ life. And you’d succeed because you would try anything until you did.

Unfortunately, while that belief might be comforting to them, the unintentional consequence is that it implies that the state of our health reflects our willpower and determination. It also puts pressure on those with chronic conditions to continually demonstrate that they are trying. Even if the best medical evidence says there isn’t anything useful left to do.

Understanding this doesn’t make it acceptable. It’s not okay to talk to someone with a chronic illness in a way that might make them feel criticised or judged. But it does make it feel less personal. I don’t know if it will be less irritating or hurtful to hear in the future, but I am hoping this might make it easier for me to feel confident in sticking to my own approach. In the past I have found myself questioning whether I am doing the right thing and feeling guilt or shame that I don’t have my illness under control.

Reflections

Kristin Neff was right to warn that self-compassion can feel worse before it feels better. Even typing out these fears again makes me feel awful. There’s a knot in my stomach. I feel very agitated and want to walk away from the task. Allowing some of this stuff to come to the surface is difficult and painful. I want to push it away and cover it up again. On the other hand I came into Compassion Focused Therapy for a good reason – I felt really bad about myself, didn’t feel I was coping well, and didn’t want to carry on like that.

I believe exploring this compassionate approach is worthwhile for me despite being very hard going at times. Exposing the underlying fears and beliefs is uncomfortable but it allows me to begin to confront them. Additionally, my methods of coping either don’t work well (e.g. self-criticism, procrastination, worrying) or aren’t available now I’m ill (e.g. perfectionism, over work). The diagram helps me see that my beliefs and coping strategies make sense, or did at the time they developed, but now I’m ready for new ones.

Working through this exercise has made me see the value of learning the soothing rhythm breathing technique before moving onto these exercises. In the group we revisited soothing breathing techniques every week, and in different variations so we could each find a way that works for us. I’m glad I put time into practise at home.

I also see why CFT self-help materials often come with advice to engage in them with the support of a counsellor. I had the opportunity to go through my diagram with a counselor and or was very helpful.